Volume 30, Issue 174, August 2026

Intentional ingestion of alcoholbased hand sanitizers in healthcare settings: a narrative review of clinical risks, toxicological concerns and patient safety implications

Laura Mikuła^1♦, Zuzanna Bogdan-Groszyk¹, Aleksandra Makulec², Katarzyna Otrębska³, Dominika Lewandowska⁴, Aleksandra Jóźwik-Szymańska⁵, Natalia Kostecka⁶, Jan Kucharski³, Helena Muszyńska², Aleksandra Szredzka⁴

¹Czerniakowski Hospital, Stępińska 19/25, 00-739 Warsaw, Poland
²Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland
³Praski Hospital of the Transfiguration of the Lord, al. “Solidarności” 67, 03-401 Warsaw, Poland
⁴Dr. Anna Gostyńska Wolski Hospital, Marcina Kasprzaka 17, 01-211 Warsaw, Poland
⁵National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137, 02-507 Warsaw, Poland
⁶Grójec District Medical Center, Piotra Skargi 10, 05-600 Grójec, Poland

^♦Corresponding author
Laura Mikuła, Czerniakowski Hospital, Stępińska 19/25, 00-739 Warsaw, Poland

ABSTRACT

Alcohol-based hand sanitizers are essential for infection prevention, but in selected clinical situations, they may also become a hidden source of highly concentrated alcohol. This narrative review synthesizes evidence on intentional or concealed ingestion of these products as a clinically relevant patient safety problem. PubMed and Google Scholar were searched for case reports, poison center studies, toxicological papers, reviews, and patient safety sources. Reference lists of key publications were hand-searched, and an official NHS England patient safety resource was also reviewed. Published reports describe ingestion in emergency departments, hospital wards, psychiatric units, addiction treatment settings, and postoperative care. The recurring pattern was the combination of patient vulnerability, access to an alcohol-containing product, and delayed recognition of sanitizer as a possible source of intoxication. Alcohol use disorder was the most consistent risk factor, but psychiatric vulnerability, self-harm risk, delirium, cognitive impairment, and older age were also relevant. Presentations ranged from apparent alcohol intoxication to respiratory depression, recurrent altered consciousness, acid-base abnormalities, cardiac arrest, and death. Persistent intoxication, rising blood alcohol concentration, or unexplained laboratory abnormalities may suggest concealed access to sanitizer. Methanol-contaminated products represent a distinct toxicological and regulatory risk, associated with severe metabolic acidosis, visual impairment, and death. Intentional or concealed sanitizer ingestion appears to be infrequently reported, but it is clinically important and potentially preventable. Prevention should be proportionate, risk-based, and non-stigmatizing, preserving infection-control standards while reducing avoidable harm in selected vulnerable patients.

Keywords: alcohol-based hand sanitizers; intentional ingestion; alcohol use disorder; methanol poisoning; patient safety

Medical Science, 2026, 30, e169ms3933

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Published: 27 August 2026